Tamoxifen and Antidepressants

Options
jai1950
jai1950 Member Posts: 38
edited June 2014 in Mental Health: Because Cancer Doesn't Just Affect Your Breasts

Hi all, I was started on Tamoxifen about two weeks ago and in researching it I found where Tamoxifen blocks the effect of SSRI antidepressants.  Has anyone had a problem with this?  It took forever to find and antidepressant that worked for me.  I sure don't want more problems.  Any input would be welcome. Thanks, Judy

· Share on FacebookShare on Twitter

Comments

  • noellech
    noellech Member Posts: 86
    edited June 2009

    Yes! I had to switch from my beloved wellbutrin to effexor. I guess some SSRIs like prozac and wellbutrin block the metabolism of tamox. I made it about 4 months on tamox with no antidepressant, but then the side effects became unbearable so I started on a quarter dose of effexor. It has really helped alot. Check out the news articles on the front page of breastcancer.org. There are new studies on this issue. Good luck. Noelle.

    · Share on FacebookShare on Twitter
  • lynnea
    lynnea Member Posts: 226
    edited June 2009

    Judy- the problem is not that tomoxifin interfers with the antidepressant, it's that certain SSRIs interfere with the metabolism of tamoxifin, rendering it ineffective in preventing future BC. I wish I could find the article in the paper, I must have tossed it. But there are some SSRIs that do not interfere with tamoxifin. Talk to your oncologist about trying a different med.

    Judy-I just read the article on the home page -the 2 interfering SSRIs are prozac and paxil. This article dosn't mention it but I believe that lexapro is one of the ones that dosn't interfere. Also the article suggested that for people that didn't want to change antidepressants, one of the aromatase inhibitors (armidex) could be used instead of tamoxifin..




    Lynne

    · Share on FacebookShare on Twitter
  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited June 2009

    The antidepressant most recommended in the recent ASCO editorial review on Tamoxifen and antidepressants is Effexor. The expert suggests it interferes the least with Tamoxifen.

     I used to have the Flockhart Table- a drug metabolism table which was very helpful in listing inhibitors of drugs like Tamoxifen. David Flockhart in fact is and was one of the original CYP2D6 researchers (I believe he's at Mayo in Minnesota). To my surprise and chagrin, when I went to my book mark of the Table the other day, a "removed" link came up. Perhaps it was too much liability to leave it up, or perhaps other incentives drove it's being taken down. 

    If your reading Dr. Flockhart: thank you for your excellent contribution to this entire CYP enzyme metabolism understanding and if you can, might you reconsider allowing public access to your well known Table?

    Hope this helps everyone,

    Tender

    PS you can use the search button here and enter CYP2D6 and Tamoxifen and antidepressant and the most recent articles about the ASCO abstract review should pop up.

    · Share on FacebookShare on Twitter
  • nene2059
    nene2059 Member Posts: 270
    edited June 2009

    Hi all.  This is something that I have really been struggling with.  I finished chemo 4 weeks ago (neoadjudavant) and my bi lateral mastectomy is coming up June 30.  I am premenopausal and will definitely be put on Tamoxifen.  I have taken Celexa for several years because, like most members of my family, without it I worry excessively (ask my husband!) and have anxiety.  A low dose of Celexa has been enough to rid me of this.  I recently tried going off of the Celexa and the symptoms came back and my onco told me to go back on as we would not be discussing Tamoxifen for at least a month because of surgery. I feel really defeated because I could not go off of it and I feel like maybe I am going to be making a decision between my mental and physical health.  I don't want to take any anti depressant while on Tamoxifen because I am afraid that whatever they tell us is ok right now will not be in a few years.  Any one know how they can tell that some inhibit strongly and some do not?  Is it through blood work? Some of what I am feeling  may just be things settling down in my body after chemo but I am so afraid to make the wrong decision regarding this.  My onco said that he believes that Celexa will definitely be put on the inhibitory list but is fine to take before I get Tamoxifen.  Sorry this has been such a long post but this has really been on my mind.  Dealing with BC at 36 is hard enough without being afraid that I may hurt my treatment because of medication that has been useful to me so far in life! Thanks for any input that anyone can give!

    · Share on FacebookShare on Twitter
  • Verebey
    Verebey Member Posts: 10
    edited July 2009

    I have been taking Zoloft for many years and started Tamoxifen 1 month ago. My doctor now has me weaning off of the Zoloft and if I need something she will start me on Effexor. The Zoloft causes the Tamoxifen to act as a placebo. That's scary. I tried just stopping Zoloft and got really sick , vomiting, tired, etc. My doctor said I needed to slowly cut down on dosage, then take the Zoloft every other day and then stop. So that's where I am right now. I want to get off as soon as possible.

    · Share on FacebookShare on Twitter
  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited July 2009

    Verebey- the SSRI's like Zoloft and the SNRI's like Effexor can be evenly exchanged I have heard. You stop one by replacing it with the new. The SE profile is the same, so then you avoid the withdrawal symptoms (feeling funny, dizzy, tingling, sick etc). Of course weaning off slowly and then adding the new antiD works well too. Good luck.

     nene2059- if you're asking about the Tamoxifen test, you might wish to use the search button here and type in CYP2D6, Tamoxifen and a number of good theads will pop up. Many large reference labs do the test: you need a rx from your doctor to bring to a large hospital and then they send the test to the reference lab. Mayo Laboratories is known to do the Tamoxifen metabolism test.

    Best,

    Tender

    · Share on FacebookShare on Twitter
  • Harley44
    Harley44 Member Posts: 5,446
    edited July 2009

    My onc thinks that even the SNRIs, like Effexor may block the metabolism of Tamoxifen...  Just a warning to any who are considering Effexor.  I took Effexor, and had a really bad time coming off it, even though I did wean myself off gradually. 

    I read somewhere... sorry, I can't find where, but the experts are saying that the SNRI's block Tamoxifen, but 'NOT AS MUCH" as the SSRIs...  still, I don't want my Tamoxifen to be blocked.  So I am not taking any antidepressants.  I'm thinking of trying one of the others, though.

    Good luck to all,

    Harley

    · Share on FacebookShare on Twitter
  • Dansmom
    Dansmom Member Posts: 82
    edited July 2009

    I just saw this on the web a few weeks ago.  I called the pharmacy (CVS) - they said no problem.  I called my oncologist at first said no problem with Wellbutrin.  Then a few days later sent me info about the problems.  CVS still says not a problem.  I took them the info from the oncologist & will f/u with them about this - it burns me up that we have to figure this stuff out ourselves.  I took HRT before my diagnosis and feel like that's why I ended up with cancer - so I'm pretty supersitious now about bad things do happen with medication.  I'm weaning off wellbutrin - guess I'll try Effexor because I can definately feel the difference.  30% of women on tamoxifin are using anti-depressants too.

    · Share on FacebookShare on Twitter
  • brewer2
    brewer2 Member Posts: 15
    edited July 2009

    And unfortunately the study comparing tamoxifin with arimedx was done before all this was known. So women were included in the TAM arm that were not properly metabolizing the drug. There is now a test to see if you are an adequate metabolizer.  I also read that certain foods interfere w tamoxifin, such as grapefruit juice.

    · Share on FacebookShare on Twitter
  • lynnea
    lynnea Member Posts: 226
    edited July 2009

    hi all - I'm bumping up this thread for people looking for info on SSRI's and tomoxifin lynne

    · Share on FacebookShare on Twitter
  • bookgirl
    bookgirl Member Posts: 128
    edited July 2009

    I just got my results back for the CYP2D6 and it shows that I am a super metabolizer. I have been taking Pristiq  for depression since Sept. Unfortunately I also tested high for potential blood clots so it looks like I will have to use something other than Tamoxifen.

    · Share on FacebookShare on Twitter
  • peejay
    peejay Member Posts: 131
    edited July 2009

    I've been taking Tamoxifen and Paxil for 3 years now. My oncologist never had a problem with it.

    Strange how things change after a few years.

    · Share on FacebookShare on Twitter
  • Dansmom
    Dansmom Member Posts: 82
    edited August 2009

    My therapist moved me over to Zoloft - already feeling better and it hasn't even been 2 weeks yet.  I went to CVS to pick up the new Rx and just got infuriated that they did not know about Wellbutrin & tamoxifin.  I gave the pharmacist the info from the doctor - he claims he tried to notify them about it, but I'm not convinced.  I really gave him a hard time about it.  Things are bad enough without finding out that your medication might not be working!

    · Share on FacebookShare on Twitter

Categories